Who Is It For?

Week 10: Ostomy Care Flashcards Preview

What is an ostomy and what are some of the reasons for having one?

Ostomy- surgically formed opening from an internal structure to the surface of the body d/t ileal atresia, necrotizing enterocolitis, imperforated anus, IBD, Hirschsprung , cancer one is too but not listed on notes

2

what is the difference between an ileostomy and a colostomy?

Ileum- right side of abdomen Drains liquid stool

Sigmoid- left lower ab Formed stool

3

What are two problems with ostomy usage?

Difficult to locate one small enough to contain liquid drainage without leaking Skin under the appliance becomes irritated

4

How are bowel diversion ostomies classified?

Classified according to: Their status as permanent or temporary Their anatomical location The nature of the construction of the stoma

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What are the reasons for having a permanent or temporary ostomy ?

Either temp or permanent

Temp: performed for traumatic injury or inflammatory conditions Allow the portion to rest and heal

Perm: provide means of elimination when the rectum or anus is non-functioning

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What are the possible locations of an ostomy?

Anatomical location

Ileostomy- liquid fecal drainage Constant drainage Contains some digestive enzymes Clients must wear an appliance continuously and take steps to prevent skin breakdown Odour is minimal because of less bacteria

Ascending colostomy Liquid drainage Digestive enzymes Increased odour

Transverse colostomy Malodourous, mushy drainage

Descending colostomy Increasingly solid fecal drainage Normal formed consistency Discharge can be regulated May not have to wear appliance all the time Odour can be better controlled

Note: Length of time ostomy in place can also determine consistency of stool, transverse and descending especially . Overtime stool is more formed because the remaining functioning portions of colon tend to compensate by increasing water absorption

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What is a urinary diversion?

Surgical rerouting of the urine from the kidneys to site other than bladder

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What is an incontinent urinary diversion?

Incontinent: no control over passage of urine and requires use of external ostomy appliance to contain urine

May or may not involve cystectomy (removal of bladder)

Nephrostomy: urine from kidney to stoma

Vesicostomy: bladder in tact but urethra is damaged Ureters remain attached to bladder and bladder wall is surgically attached to stomas below navel

Most common diversion is a ileal conduit/ileal loop Segment of ileum is removed and the intestine ends are reattached One end of the portion creates the pouch and the other end forms the stoma Ureters are implanted into the ideal pouch Provides more protection from organisms and easier to fit for appliance Urine drains continuously

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What is the most common type of urinary diversion?

Most common diversion is a ileal conduit/ileal loop Segment of ileum is removed and the intestine ends are reattached One end of the portion creates the pouch and the other end forms the stoma Ureters are implanted into the ideal pouch Provides more protection from organisms and easier to fit for appliance Urine drains continuously

10

What are the disadvantages to a ureterostomy?

What is a continent urinary diversion?

Continent: continence mechanism is created by giving control over the passage of urine Intermittent catherization or strained voiding Indiana pouch: created by attaching the ureters to a portion of the ileum that is shaped into a reservoir for urine The client then inserts the catheter through an opening in the ab wall to empty the reservoir Usually every 4 hrs Neobladder: replaces a diseased or damaged bladder with a piece of ileum Making a new bladder The new bladder is then sutured to the functional urethra, allowing the person to urinate normally

What must the nurse assess for a urinary diversion?

patient is at risk for ____ ( urinary diversion)

Pts at risk for skin irritation

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What does effluent mean?

output from stoma

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How is the Urostomy or ileal conduit created ?

Urostomy or ileal conduit is created from a portion of intestine that is resected from ileum One end of the conduit is sutured closed, and the ureters are implanted through the mucosa. The other end is brought out on the abdominal wall, and a stoma is formed for urine to exit the body. This ostomy is permanent.

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What are the changes or trends with ostomies now adays?

Changes/trends: The current trend is to apply a pouch directly to clean dry skin without using skin preparations, paste, or added adhesives unless a patient has a specific problem keeping a pouch intact The adhesives on the skin barriers are pressure and heat sensitive; thus a patient should apply gentle pressure with the hand over the skin barrier for several minutes to adhere the barrier to the skin There are new and improved accessory products such as rings or seals for managing abdominal contours that are uneven or peristomal skin that is not intact. Some pouches have effective gas filters that allow flatus to escape slowly from the pouch through a charcoal filter. This filter absorbs odor and does not allow leakage of liquid effluent through the filter. All of the ostomy companies now have pouches with integrated closures. A Velcro-like closure eliminates the need for a clip to close the bottom of the pouch. It also requires less manual dexterity to empty the pouch. A wider selection of products for neonatal and pediatric use

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What are some differences with neonate ostomies? infant ostomies? why might they need them, etc?

Because most ostomy surgery done on neonates is for emergencies, often no time is available for preoperative selection of stoma site. The surgery is usually done because the neonate has necrotizing enterocolitis (NEC), Hirschsprung’s disease, or congenital disorders. The stomas are frequently temporary, with closure of the ostomy when the surgical repair has healed and the neonate is medically ready for surgery. Because infants swallow large amounts of air while sucking, it is normal to expect flatus. Make sure that pouch can accommodate increased amount of flatus after feeding or be prepared to release flatus frequently

• The skin of a preterm infant is not fully developed and is more absorbent than that of a full-term infant. Do not use skin sealants and adhesive removers unless they are approved for preterm-infant use

• As an infant grows in size, so does the stoma. Measure the stoma frequently and make appropriate adjustments in pouching and skin barrier size. Skin barriers for preterm infants must have flexibility to cover the infant’s rounded abdominal contour

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Why are some reasons children have ostomies?

Children and adolescents may have ostomy surgery for conditions such as cancer, inflammatory bowel disease, and trauma.

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What are some gerontologic considerations?

Gerontologic • Evaluate an older adult’s cognitive status for understanding ostomy self-care instructions. Include a family caregiver in the care plan. • Adapt care approaches for older patients who have impaired manual dexterity or limited vision. If a patient is unable to custom cut the size of the skin barrier, consider having barriers precut by an ostomy equipment supplier or using a precut pouching system.

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Ostomies- What are some homecare teaching points?

Evaluate home toileting facilities and patients’ ability to position to empty pouch directly into a toilet. • Patient may shower without covering pouch. • Patients should avoid storing pouches in extremely hot or cold locations. Temperature affects barrier and adhesive materials.

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How often should you check the bag (ostomies / childre)

Check bag every 4 hrs

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How long can the collection bag remain in place (ostomies / children)

Collection bag may stay in place for as long as one week if properly secured

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How can you reduce the odor (ostomies/ children)

To reduce odor: flush appliance with warm water and soap, use bulb syringe, rinse with clear water

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What are some complications of NG feeding (mercks manual- see notes week 8-13 for reading list of complications, signs and interventions, but these are similar)

Presence of tube-> Damage to the nose, pharynx, or esophagus- Sinusitis (The tube, particularly if large, can irritate tissues, causing them to erode. Sinus ostia can become blocked).

Blockage of tube lumen->Inadequate feeding(Thick feedings or pills can block the lumen, particularly of small tubes. Sometimes blockages can be dissolved by instilling a solution of pancreatic enzymes or other commercial products)

Misplacement of a nasogastric tube intracranially -->Brain trauma, infection (A tube may be misplaced intracranially if the cribriform plate is disrupted by severe facial trauma.

Misplacement of a nasogastric or orogastric tube in the tracheobronchial tree -->Pneumonia (Responsive patients immediately cough and gag. Obtunded patients have few immediate symptoms. If misplacement is not recognized, feedings enter the lungs, causing pneumonia)

Dislodgement of a gastrostomy or jejunostomy tube --> Peritonitis (After being dislodged, a tube may be replaced into the peritoneal cavity. If tubes were originally placed using invasive techniques, replacement is more difficult and more likely to cause complications.)

Formula-related -->Intolerance of one of the formula’s main nutrient components --> Diarrhea**MOST COMMON**, GI discomfort,* nausea, vomiting, mesenteric ischemia (occasionally) (Intolerance occurs in up to 20% of patients and 50% of critically ill patients and is more common with bolus feedings)

Other

Reflux of tube feedings or difficulty with oropharyngeal secretions -->Aspiration (Aspiration may occur even though tubes are placed correctly and the head of the bed is elevated if patients have either of these problems)

*GI discomfort may have other causes, including reduced compliance of the stomach due to shrinkage caused by lack of feeding, distention due to volume of feeding, and decreased gastric emptying due to dysfunction of the pylorus.